Your Child's First Dental Evaluation

First Visit By First Birthday

At What Age Should my Child See a Pediatric Dentist?

Just For Grins Pediatric Dentistry endorses the recommendations made by The American Academy of Pediatric Dentistry (AAPD) AND The American Academy of Pediatrics (AAP) that the first dental evaluation take place within 6 months of the eruption of the first primary (“baby”) tooth, and not later than 12 months of age.


1. This recommendation is based upon the philosophy of care that anticipatory guidance is the most efficient means of preventing cavities and other forms of oral pathology (disease).

What is Anticipatory Guidance?
It is a proactive, developmentally based counseling system that focuses on the needs of a child at a particular stage of life. This allows the parents the opportunity to talk about their child, obtain age-appropriate information, and to look at how growth and the environment will affect their child’s oral health in the coming months. This is similar to the counseling your child receives at her regular visits with her pediatrician.

2. Establishment of the Dental Home should occur not later than age 12 months.

But, I Often Hear That the First Dental Exam Occurs at Age 3.

There is no guideline suggesting age 3 for the first dental exam. This is an outdated practice based upon presumptions about a child’s ability to cooperate in the dental setting, not on the absence of dental disease (decay, cavities, etc.). Infants and toddlers do experience dental disease. The most destructive form is Early Childhood Caries. Decay that is diagnosed in a 3-year-old started well before age 3. The ‘at-risk’ patient does not have the advantage of prevention if he waits until his 3rd birthday for his first exam. In fact, the majority of Early Childhood Caries cases that are scheduled for surgery under general anesthesia occur in children 3 years old and younger.

We prefer to avoid dental disease, rather than to treat it. Tooth decay, if left untreated even in the earliest stages of life, can have serious implications for a child’s long-term health and well being. Early preventive care is a sound health and economic investment. Parents may not take young children to the dentist for a variety of reasons. However, an October 2004 study in the journal Pediatrics showed that the dental costs for children who have their first dental visit before age one are 40 percent lower in the first five years than for those who do not see a dentist before their first birthday.

Pediatrics also reported that early childhood caries can be prevented through early professional dental care complemented with caries risk assessment, anticipatory guidance, and periodic supervision.

In addition, without preventive care, the impact of tooth decay on child development can be significant. Childhood cavities have been linked to lower than ideal body weight and lost time in school. The effects of poor oral health may be felt for a lifetime.

Infant & Toddler Care

When should my child first see the dentist?

“First visit by first birthday” sums it up. You child should first visit a pediatric dentist when the first tooth comes in, usually between 6 and 12 months of age. This visit will establish a dental home for your child.

Early examination and preventive care will protect your child’s smile now and in the future.

Why so early? What dental problems could a baby have?

The most important reason is to begin a thorough preventive program. Dental problems can begin early.

A big concern is Early Childhood Caries (formerly known as baby bottle tooth decay or nursing caries). Once a child’s diet includes anything besides breast-milk, erupted teeth are at risk for decay. The earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily and smile with confidence. Start your child now on a lifetime of good dental habits.

How can I prevent tooth decay from nursing or using a bottle?

  • At-will (ad libitum) breast-feeding should be avoided after the first deciduous (primary, baby) teeth begin to erupt and other sources of nutrition are introduced.
  • Children should not fall asleep with a bottle containing anything other than water.
  • Drinking juice from a bottle should be avoided.
  • Fruit juice should be offered in a cup with meals, or not at all.

When should bottle-feeding be stopped?

Children should be weaned from the bottle at 12-14 months of age.

Should I worry about thumb and finger sucking?

Thumb sucking is perfectly normal for infants; many stop by age 2.

Prolonged thumb sucking can create crooked teeth or bite problems. If a habit continues beyond age 3, a professional evaluation is recommended. Your pediatric dentist will be glad to suggest ways to address a prolonged thumb sucking habit.

When should I start cleaning my baby’s teeth?

The sooner the better!

Starting at birth, clean your child’s gums with a soft infant toothbrush or cloth and water. As soon as the teeth begin to appear, start brushing twice daily.

Until the age of 2-3, when a child is unable to spit thoroughly, use toddler toothpaste. When you initiate the use of fluoride toothpaste, use only a ‘smear’ of toothpaste to brush. After age 3, you can dispense a small ‘pea-size’ amount of toothbrush and perform your child’s tooth brushing. Remember that young children do not have the ability to brush teeth effectively.

Any advice on teething?

From 6 months to age 3 years, your child may have tender gums when teeth erupt. Many children like a clean teething ring, cool spoon, or cold / frozen wet washcloth. Some parents swear by a chilled ring, others simply rub the baby’s gums with a clean finger.

Preventive Dentistry

What is preventive dentistry?

  • brushing
  • dental development
  • flossing
  • fluoride
  • oral habits
  • orthodontics
  • parent involvement
  • proper diet
  • sealants
  • sports safety

Preventive Dentistry discussions repeat every 6 months at the RECARE appointment.

Why is preventive dentistry important?

Preventive dentistry means a healthy smile for your child. Children with healthy mouths chew more easily and gain more nutrients from the foods they eat. They learn to speak more quickly and clearly. They have a better chance of general health, because disease in the mouth can endanger the rest of the body. A healthy mouth is more attractive, giving children confidence in their appearance. Finally, preventive dentistry means less extensive and less expensive treatment for your child.

When should preventive dentistry start?

Preventive dentistry begins with the first tooth. Visit your pediatric dentist at the eruption of the first tooth or by age one. You will learn how to protect your infant’s dental health. The earlier the dental visit, the better the chance of preventing dental disease and helping your child build a cavity-free smile.

What role do parents play in prevention?

After evaluating your child’s dental health, your pediatric dentist will design a personalized program of home care for your child. This program will include brushing and flossing instructions, diet counseling, and if necessary, fluoride recommendations. By following these directions, you can help give your child a lifetime of healthy habits.

How do pediatric dentists help prevent dental problems?

Tooth cleaning and polishing and fluoride treatments are all part of your child’s prevention program. However, there is much more. For example, your pediatric dentist can apply sealants to protect your child from tooth decay, help you select a mouth guard to prevent sports injuries to the face and teeth, and provide early diagnosis and care of orthodontic problems. Your pediatric dentist is uniquely trained to develop a combination of office and home preventive care to insure your child a happy smile.


What are sealants?

Sealants are low viscosity resin material used to protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free. The sealants used in our office are made by 3M ESPE and manufactured in the United States.

How do sealants work?

Even if your child brushes and flosses carefully, it is difficult—often impossible—to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these crevices, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, thus reducing the risk of decay.

How long do sealants last?

Research shows that sealants can last for many years if properly cared for. Therefore, your child will be protected throughout the most cavity-prone years.

If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. Your pediatric dentist will check the sealants during routine dental visits and recommend re-application or repair when necessary.


Before sealant. After sealant.

What is the treatment like?

The application of a sealant is quick and comfortable. It takes only one visit. The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and allowed to harden or hardened with a special light. Your child will be able to eat right after the application.

How much does it cost?

The treatment is very affordable; especially in view of the valuable decay protection that it offers your child. Most dental insurance companies cover sealants. Some companies, however, have age and specific tooth limitations. Check with your benefits provider about your child’s coverage and talk to your pediatric dentist about the exact cost of sealants for your child.

Which teeth should be sealed?

The natural flow of saliva usually keeps the smooth surfaces of teeth clean but does not wash out the grooves and fissures. So, the teeth most at risk of decay—and therefore, most in need of sealants— are the six-year and twelve-year molars. Many times the permanent premolars and primary molars will also benefit from sealant coverage. Any tooth, however, with grooves or pits may benefit from the protection of sealants. Talk to your pediatric dentist, as each child’s situation is unique.

If my child has sealants, are brushing and flossing still important?

Absolutely! Sealants are only one step in the plan to keep your child cavity- free for a lifetime. Brushing, flossing, balanced nutrition, limited snacking, and regular dental visits are still essential to a bright, healthy smile.

Regular Dental Visits (Recare)

How often should a child see the dentist?

The American Academy of Pediatric Dentistry recommends a dental check-up at least twice a year for most children. Some children need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns or poor oral hygiene. Your pediatric dentist will let you know the best appointment schedule for your child. These appointments are also known as RECARE appointments.

Why visit the dentist twice per year when my child has never had a cavity?

Regular dental visits help your child stay cavity-free. Teeth cleanings remove debris that build up on the teeth, irritate the gums and cause decay. Fluoride treatments renew the fluoride content in the enamel, strengthening teeth and preventing cavities. Hygiene instructions improve your child’s brushing and flossing, leading to cleaner teeth and healthier gums.

Tooth decay is not the only reason for a dental visit. Your pediatric dentist provides an ongoing assessment of changes in your child’s oral health. For example, your child may need additional fluoride, dietary changes or sealants for ideal dental health. The pediatric dentist may identify orthodontic problems and suggest treatment to guide the teeth as they emerge in the mouth.

What happens in a dental check-up?

The pediatric dentist will review your child’s medical and dental history. He or she will gently examine your child’s teeth, oral tissues and jaws. The teeth will be cleaned and polished, followed by the application of fluoride varnish.

Your pediatric dentist will not just talk to you about dental health, he or she will talk to your child with easily understandable words, pictures and ideas. Your child will be motivated to take responsibility for a healthy smile.

Will X-rays be taken at every appointment?

No. Pediatric dentists, acting in accordance with the guidelines from the American Academy of Pediatric Dentistry, recommend X-rays only when necessary to protect your child’s dental health. For example, X-rays may be needed to diagnose tooth decay or abnormalities. They may also be required for orthodontic treatment. Your pediatric dentist will discuss the need for X-rays with you before any are taken.

How can I help my child enjoy good dental health?

The following steps will help your child be part of the cavity-free generation:

  1. Beware of frequent snacking
  2. Brush effectively twice a day with a fluoride toothpaste
  3. Floss once a day (we recommend before bedtime)
  4. Have sealants applied when appropriate
  5. Seek regular dental check-ups
  6. Assure proper fluoride through drinking water, fluoride products or fluoride supplements.

Emergency Care

When your child needs urgent dental treatment, your pediatric dentist stands ready to help. Please keep the emergency number available and convenient.

(505) 428-7878

What should I do if my child’s baby tooth is knocked out?

Contact your pediatric dentist as soon as possible. The baby tooth should not be replanted because of the potential for subsequent damage to the developing permanent tooth.

What should I do if my child’s permanent tooth is knocked out?

Find the tooth and rinse it gently in cool water. (Do not scrub or clean it with soap –– use only water!) If possible, replace the tooth in the socket immediately and hold it there with clean gauze or a wash cloth. If you can’t put the tooth back in the socket, place the tooth in a clean container with cold milk, saliva or water. Get to the pediatric dental office immediately. (Call the emergency number if it’s after hours.) The faster you act, the better your chances of saving the tooth.

What if a tooth is chipped or fractured?

Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling if the lip also was injured. If you can find the broken tooth fragment, place it in cold milk or water and bring it with you to the dental office.

What about a severe blow to the head or a jaw fracture?

You need immediate medical attention.

A severe head injury can be life threatening. Keep in mind that an emergency medical team might be able to reach you faster than you can get to the hospital.


What if my child has a toothache?

Call your pediatric dentist and visit the office promptly. To comfort your child, rinse the mouth with water. Over-the-counter children’s pain medication, dosed according to your child’s weight and age, might ease the symptoms. You may apply a cold compress or ice wrapped in a cloth to the face in the area of the pain, but do not put heat or aspirin on the sore area.

Can dental injuries be prevented?

Your child’s risk for dental injuries can be reduced greatly by following a few simple suggestions.

First, reduce risk for severe oral injury in sports by wearing protective gear, including a mouthguard.

Second, always use a car seat for young children and require seat belts for everyone else in the car.

Third, childproof your home to prevent falls and electrical injuries.

Regular dental check-ups provide your dentist an opportunity to discuss additional age- appropriate preventive strategies with your child.

Read more in an article for Tumbleweeds written by Dr. Elizabeth Prishkulnik here.

Second Opinion Recommendation

The American Academy of Pediatric Dentistry (AAPD) recognizes that second opinions are one avenue for additional information regarding health care issues. Parents frequently seek additional information and/or other opinions in order to address their child’s health care needs and make informed decisions.

When is a second opinion is recommended?

  • when the parent disagrees with or questions the diagnosis or the treatment plan of the health care provider,
  • when the patient has multiple medical problems that affect the approach of treatment delivery,
  • when there is no improvement in the patient’s condition,
  • when there is a communication barrier between the patient and the provider,
  • when extensive oral care needs or high cost may make treatment prohibitive, and
  • when required by a third party payor.

Who should be consulted for a second opinion?

  • a provider who is trained and experienced in diagnosing and treating the condition should provide the second opinion. In many cases, the second opinion is requested because of high cost associated with the particular treatment plan. Remember that when comparing information and cost, a general practitioner and a specialist who had been trained in the field are not always comparable.
  • internet sites or a telephone conversation cannot be relied upon and should not constitute a second opinion.

What is the goal of a second opinion consultation?

  • educating the patient regarding the diagnosis and available treatment options, Including their risks and benefits,
  • to render opinions on careful consideration of all the facts and with due attention given to current and previous states of the patient.

What else should I know about second opinion consultation?

  • Most second opinions are voluntary. It is the responsibility of the patient to check with his/her insurance carrier for specific policies and benefits regarding coverage of second opinions.
  • Health Insurance Portability and Accountability Act (HIPAA) privacy rules and state laws apply to all exchanges of health care information between your provider and the provider conveying the second opinion.
  • Some second opinions are mandatory by third party payors. At times insurance companies, court orders, and in other special circumstances, a second opinion is paid for and mandated by a third party. Do not expect this, unless it has been explicitly expressed to you about your case.
  • The provider of the second opinion should be independent and the opinion should be based on best outcomes for the patient and not financial incentives.

Out-patient Surgery & General Anesthesia

What is general anesthesia?

General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement, and discomfort during dental treatment. A physician or dentist with specialized training can use various medications to provide general anesthesia for patients receiving dental care.

General anesthesia will take place in a hospital or outpatient facility, not in our office.

Who should receive general anesthesia for dental treatment?

General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful, anxious, or for the very young who do not understand how to cope. General anesthesia also can be helpful for children requiring significant surgical procedures or patients having special health care needs.

Is general anesthesia safe?

Although there is some risk associated with general anesthesia, it can be used safely and effectively when administered by an appropriately trained individual in an appropriately equipped facility. Precautions are taken to protect your child during general anesthesia and personnel who are trained to manage complications will monitor your child closely. Your pediatric dentist will discuss the benefits and risks of general anesthesia and why it is recommended for your child.

What special considerations are associated with the general anesthesia appointment?

A physical evaluation is required before general anesthesia for dental care. This physical assessment provides information to ensure the safety of your child during the general anesthesia procedure. Your pediatric dentist or general anesthesia provider will advise you about evaluation appointments that are required.

Parents are instructed to report to the pediatric dentist any illness that occurs before the general anesthesia appointment. It may be necessary to reschedule the appointment.

It is very important to follow instructions regarding fasting from fluids and foods before the appointment.

Your child will be discharged when stable, alert, and ready to depart.

Patients often are tired following general anesthesia. You will be instructed to let the child rest at home with minimal activity until the next day. Post- operative dietary recommendations also will be provided.

Special Health Care Needs

What are special health care needs?

  • Special health care needs include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.
  • The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity.

Why is Pediatric Dentistry well suited for this patient?

  • Health care for individuals with special needs requires specialized knowledge acquired by additional training, as well as increased awareness and attention, adaptation, and accommodative measures beyond what are considered routine.
  • Residency training for the specialty of Pediatric Dentistry includes didactic and clinical care for the special health care needs patient in multiple settings, including clinic, office, hospital, emergency, and surgical outpatient settings.

Nitrous Oxide

Most children are calm, comfortable, and confident in our pediatric dental office. The office is designed for young people, and pediatric dentists have additional training in caring for infants, children, and adolescents. Staff members choose to work in a pediatric dental office because they like children and want to cater to their special needs. These elements combine to make your child feel relaxed and special.

Sometimes, however, a child may feel anxious before or during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective sedative agent used to calm a child’s fear of the dental visit and enhance effective communication. Additionally, it works well for children whose gag reflex interferes with dental treatment.

What is nitrous oxide/oxygen?

Nitrous oxide/oxygen (N2O-O2) is a blend of two gases—oxygen and nitrous oxide. A fitted nasal mask is placed over the NOSE. This nasal mask or ‘nose-piece’ is scented (unscented is available) and the child can choose their own scent. As the child breathes normally, uptake of both gases occurs through the lungs. At the end of treatment, it is eliminated after a short period of breathing oxygen and does not have lingering effects.

How will my child feel when breathing nitrous oxide/oxygen?

Your child will smell a faint sweet aroma and scent and experience a sense of well-being and relaxation. Since it may produce a feeling of giddiness or euphoria, it is often called “laughing gas.” Children sometimes report dreaming and their arms and legs may feel “tingly.” It raises the pain threshold and may even make the time appear to pass quickly. If your child is worried by the sights, sounds, or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen.

How safe is nitrous oxide/oxygen?

Very safe. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is well tolerated. It has a rapid onset, is reversible, can be adjusted in various concentrations, and is non-allergenic. Your child remains fully conscious—keeps all natural reflexes— when breathing nitrous oxide/oxygen. He/she will be capable of responding to a question or request. Nitrous oxide/oxygen may also be used in combination with other sedative agents (though our office does not use agents).

Are there any special instructions for nitrous oxide/oxygen?

First, give your child little or no food in the two hours preceding the dental visit (occasionally, nausea or vomiting occurs when a child has a full stomach). Second, tell your pediatric dentist about any respiratory condition that makes breathing through the nose difficult for your child, as it may limit the effectiveness of nitrous oxide/oxygen. Third, tell your pediatric dentist if your child is taking any medication on the day of the appointment.

Will nitrous oxide/oxygen work for all children?

Pediatric dentists know that all children are not alike. Every service is tailored to your child as an individual. Nitrous oxide/oxygen may not be effective for some children, especially those who have severe anxiety, nasal congestion, or discomfort wearing a nasal mask. Your pediatric dentist will review your child’s medical history, level of anxiety, and dental treatment needs and inform you if nitrous oxide/ oxygen is recommended for your child. Pediatric dentists have comprehensive specialty training and can offer other sedation methods that are right for your child. In our office, the alternative is general anesthesia.

Thumb, Finger, and Pacifier Habits (Habits & Appliances)

Why do children suck on fingers, pacifiers or other objects?

This type of sucking is completely normal for babies and young children. It provides security. For young babies, it is a way to make contact with and learn about the world. In fact, babies begin to suck on their fingers or thumbs even before they are born.

Are these habits bad for the teeth and jaws?

Most children stop sucking on thumbs, pacifiers or other objects on their own between 2 and 4 years of age. However, some children continue these habits over long periods of time. In these children, the upper front teeth may tip toward the lip or not come in properly. Frequent or intense habits over a prolonged period of time can affect the way a child’s teeth bite together, as well as the growth of the jaw and bones that support the teeth.

What are Space Maintainers?

What Are Space Maintainers?

Space maintainers are appliances made of metal or plastic that are custom fit to your child’s mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days. They serve as their name suggests, to “hold” a space for an incoming tooth that had not yet erupted through the gum line.

Why Do Children Lose Their Baby Teeth?

Humans have two sets of teeth; the primary (20) and the permanent (32). As a child grows, the bones grow, thus allowing more teeth to fit on the upper (maxilla) and lower (mandible) jaws. There is a general and particular order for the teeth to erupt and to fall out. A baby tooth usually stays in place until a permanent tooth underneath ‘pushes’ it out and takes its place.

Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.

Why All The Fuss? Baby Teeth Fall Out Eventually On Their Own!

Baby teeth are important to your child’s present and future dental health. They encourage normal development of the jaws, bones and muscles. They save space for the permanent teeth and guide them into position.

Remember: Some baby teeth are not replaced until a child is 12 or 14 years old.

How Does A Lost Baby Tooth Cause Problems For Permanent Teeth?

If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent teeth. Therefore, permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.

How Does A Space Maintainer Help?

Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It is usually more affordable – and easier on your child – to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.

What Special Care Do Space Maintainers Need?

Pediatric dentists have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second, do not tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious brushing and flossing. Fourth, continue with regular dental visits.

In addition to the listed services, Just for Grins Pediatric Dentistry offers comprehensive care to meet all your pediatric dentistry needs. Please contact us for a complete list of services.